Copy of Bulk Rate Transcript Order Form.xls by tamir13

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									               NOVA SOUTHEASTERN UNIVERSITY
               Office of Student Financial Services & Registration
               3301 College Avenue , P.O. Box 299000
               Fort Lauderdale-Davie, FL 33314-7796                         Bulk Rate Transcript Request
               (954) 262-3380 800-806-3680 Fax (954) 262-4862


Please print clearly. You must complete ALL information requested.             Nondegree              Program Major ________________
 Transcripts will not be releaseed with existing (hold(s) on record.           Undergraduate          Program Major ________________
 Transcripts will not be released until all accounts are paid in full          Master's               Program Major ________________
 Include dates of enrollment in the space provided.                            Ed. Specialist         Program Major ________________
 You can either mail this form to the above address or fax it to:              Law                    Program Major ________________
 (954) 262-4862                                                                Doctoral               Program Major ________________
 IMPORTANT: All bulk transcripts will only be mailed to one address. Each      Health Professions     Program Major ________________
 transcript will be enclosed in a separate envelope - with no address
 indicated on it. All transcripts will then be placed in one envelope.      Dates of Enrollment _____________ to ______________


Present Name                                                                _____ Number of transcripts requested

                                                                                   # of Transcripts   Charge
Name used at Nova Southeastern University                                           11 to 20          $55
                                                                                    21 to 40          $85
                                                                                    41 to 60          $100
NSU ID/SSN                                                                          61 or more        $125

                                                                            Enter total charge based upon # reqeusted $_________
Address

                                                                            Method of payment
City                                      State                      Zip
                                                                               Credit Card      Check          Cash *

Telephone                                                                   I hereby authorize a charge to be made to my credit card:


E-Mail Address                                                              Account number


Signature (required)                                                        Expiration date

Select one below:
                                                                            Amount
_____ Mail Transcripts to:

                                                                            Signature                                    Date
            Name
                                                                            *Cash can only be accepted at the One-Stop Shop

            Address                                                                             FOR OFFICE USE ONLY

                                                                            Transcript fee 2021
            City                          State                      Zip    Amount due:       $__________
                                                                            Amount rec'd:     $__________ By: __________________
_____ Hold transcripts for pick-up at the One-Stop Shop                     Cred bal/ref:     $__________
         _____ Email me when ready                                          Date Issued: ______________ By: ______________________
         _____ Call me when ready

								
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